HEALTH AND ENVIRONMENT

Building Malaria Modeling Capacity in Sub-Saharan Africa

The basics of malaria

Biology and epidemiology: Malaria is an entirely preventable and treatable disease. It is caused by a protozoan parasite of the genus Plasmodium and is transmitted from person to person by Anopheles mosquitoes. There are over 400 different species, but only 30 are important vectors of malaria.

Five species of the genus Plasmodium can infect humans. Two of them, P. falciparum and P. vivax, pose the greatest threat. Although P. vivax can cause acute and fatal infection, P. falciparum is the most dangerous malaria parasite. It is also most prevalent on the African continent and is responsible for most malaria deaths.

 INDICATOR: Incidence of malaria and mortality rate due to this disease

1- Global Progress

In 2000, more than 80% of cases and 90% of deaths occurred in sub-Saharan Africa, where children under 5 were particularly vulnerable to the acute and fatal form of the disease.

 2- challenges to overcome

Despite the spectacular progress recorded in sub-Saharan Africa and even if deaths due to malaria have been avoided more than elsewhere, it is in this region of the world that the disease is most severe. In 2015, it was estimated that the 15 hardest-hit countries, most of which are in sub-Saharan Africa, alone accounted for 80% of malaria cases and 78% of deaths. The decrease in the incidence of the disease in these 15 countries between 2000 and 2015, of 32%, remains far behind that observed in the other 54% countries. Declining incidence must be greatly accelerated in these countries to improve global progress.

  3- Proportion of children under 5 sleeping under insecticide-treated mosquito nets,

Progress made:

The indicator is analyzed only for sub-Saharan Africa, where malaria mainly affects children under 5 and mosquitoes mainly bite at night.To guarantee the protection of the most vulnerable populations, the indicator must reach high values, ideally 100%.

  4- Achieving and sustaining universal coverage: two phases, two goals
• Scaling up interventions for real impact: during this phase, the goal is to rapidly achieve universal coverage for all at-risk populations through locally adapted, health systems-based malaria control interventions reinforced.
• Sustained control: during this phase, the objective is to maintain universal coverage through the constant strengthening of health systems, until universal coverage is exhausted by elimination or until research in the field suggest that it can be reduced without risk of resurgence of malaria.

The scale-up and sustained control phases share two main activities: strengthening systems to enable malaria control and expanding and sustaining universal coverage with appropriate interventions. These two complementary activities begin with the scale-up phase and continue into the sustained control phase to ensure continued reduction in mortality and morbidity.

FIGHT AGAINST MALARIA

Achieve universal coverage with tailored interventions. Scaling up interventions and maintaining universal coverage (100%) of appropriate interventions for the entire population at risk with a target of at least 80% utilization will lead to a considerable reduction in morbidity and malaria mortality.
PREVENTION:
 Universal coverage for prevention means that 100% of the population at risk receives appropriate preventive interventions given the local context. For these interventions, coverage is defined as follows:
• Long-lasting insecticide-treated mosquito nets (LLINs): A household should have one long-lasting insecticide-treated bed sheet for every two people living in the household.
• Indoor residual insecticide (IRS) spraying: the interior walls of each dwelling are systematically sprayed with an effective insecticide, respecting the appropriate interval between two sprays.
• Intermittent preventive treatment (IPTp): A pregnant woman living in an area with high transmission receives at least two doses of an appropriate antimalarial during her pregnancy.
• Other vector control interventions: other targeted approaches (eg larviciding and environmental management, etc.), based on scientific evidence, are used where appropriate.
CASE MANAGEMENT: Universal coverage means that 100% of patients receive appropriate case management interventions given the local context. For these interventions, coverage is defined as follows:
• Diagnosis: A patient receives rapid parasitological confirmation of the diagnosis of malaria (by microscopy or rapid diagnostic test [RDT], with certain exceptions).
• Treatment: An infected person receives the appropriate antimalarial treatment for uncomplicated or severe malaria within 24 hours of onset of illness.

Careful attention is needed to ensure that interventions reach the most vulnerable populations and that gender (male/female), socio-economic status or geographic location is not a barrier to accessing these interventions.

●The vaccine, a safe and effective way to fight against malaria.

Strengthening health systems to enable the fight against malaria and to achieve and maintain universal coverage requires considerable effort.

Support element 1: Take advantage of innovation and develop research.

Supporting element 2: Making the environment more favorable

IDEAL, OBJECTIVES AND PRINCIPLES is that of a world without malaria or zero malaria

PROPOSED POLICY FRAMEWORK:

Until new tools and improved approaches arrive, we urgently need to adopt the recommended set of strategies and expand their application to improve the effectiveness of interventions and end preventable deaths from malaria.

● Development of a schedule for the work system, namely:

  ─ Organize work, meeting, conference and training sections

  ─ Plan the field work.

● Training of community champions and insecticide spray technicians to support the program.

● Awareness campaign to support the zero malaria program through:

  ─ The media, TV channels and radio broadcasting

  ─ Billboards, advertising on buses for a period of two months.

  ─ Massive distribution of program brochures to the community

  ─ Organize film screenings

  ─ Coordinate work with the health system

    ─ Create a network of people working for change.

 ● Organization of the work process:

  ─ Community champions should bring a Kit: a backpack, long-lasting insecticide-treated bed nets and pharmaceuticals for malaria prevention, a smartphone, communication equipment and a salary.

  ─ Mosquito control technicians, divided into groups or cells, supervising a section chief, will be distributed in the following areas: towns, villages, countryside and farms.

● Duties: Locate and treat larval areas or mosquito breeding areas.

  Apply the residual insecticide spray inside the premises: dwellings, public places, etc.

 Means of transport: car, motorcycle and tricycles

 ● in conclusion, the success of this project will depend on the innovation and the type of financing for a zero malaria world.

Health systems are complex entities with many stakeholders, including patients, doctors, hospitals, medical providers, purchasing organizations, regulators, public authorities and the population as a whole. . These stakeholders are linked by a series of relationships
based on mutual accountability

Intervener: public authority
Example of needs:
- Monitor the health status of the population
- Determine health policies
- Ensure the proper functioning of procedures
regulatory
- Ensure that public funds are used as the
wanted the authorities
- Ensure that the information functions
and appropriate research are put in place
- Study the degree of effectiveness and efficiency of laws and
regulations

Data needed:
- National performance information
and international
- Information on access to care and equity in the provision of
care
- Information on the use of services and deadlines
waiting
- Population health data
- Regulators

  We are of African origin, and compared to the world, Africa suffers from a triple burden of communicable, non-communicable and socio-behavioural diseases, to which must be added illiteracy, poverty and underdevelopment. It generally ranks last in all health and development indicators.

   Health indicators in sub-Saharan Africa are among the worst in the world. They testify to the poor performance of the approaches used so far.
We demonstrate this with the example of malaria, which is the leading cause of consultation and hospitalization in most countries of the region, despite the appreciable efforts made by countries to reduce the burden of this condition over the last decade and which are beginning to show encouraging results. Looking closely at health systems efforts in the region, it is clear that the emphasis is on strategies that focus on disease as a distinct entity unrelated to socio-economic development.
Our programs focus mainly on the diagnosis and treatment of diseases with prevention components which themselves fall within the field of disease and not health (community awareness program from a preventive point of view, for example: use of insecticide-treated mosquito nets, treatment of outbreaks by spraying with residual insecticides, etc.) Conferences with changes of ideas, planning.
We encounter in our journeys with the communities the following questions:
Can we really reduce maternal mortality without reducing poverty, without educating women and without empowering women? Or will we be able to reverse the downward trend in tuberculosis without reducing poverty for a disease strongly correlated with it? Is infant mortality not just as strongly associated with the level of education of the mother?
 The answer is unequivocal and calls for a rescaling of disease control strategies. In this sense, it is important that the region's health systems learn to understand the strategy of “health in all policies”, one of the five pillars of health promotion. This will enable them to take full advantage of the many resources already existing and invested in other sectors such as education, urban planning, agriculture, water and sanitation, public works and transport, employment, etc.

We postulate this challenge on 6 main elements in the context of strengthening health systems:
1. Leadership and governance. This includes strong political commitment to the fight against malaria, clear definition of policy and funding frameworks in line with international recommendations, regulations, leadership and support from national authorities to carry out planning efforts. and coordinate
and align all partners.
2. Sustainable financing and social protection. It is essential that malaria programs have access to adequate resources at the right time for planned activities, to ensure that populations at risk are covered by the required interventions without excessive personal contribution.
3. Health personnel. Sufficient numbers, well-trained, well-distributed and productive staff are needed to deliver the highest quality interventions possible.
4. Medical products, technologies, infrastructure and logistics. Effective and cost-effective prevention and case management tools must be made available to all at-risk populations.
5. Provision of Services. Good health services are those that provide effective, safe and quality interventions to the people who need them, when and where they are needed, with a minimum of waste of resources.
6. Health information system. The health information system ensures the production, analysis, dissemination and use of reliable and up-to-date information. It includes monitoring and evaluation, disease and mortality surveillance, disease mapping and information technology.

Allo Hygiene Plus seeks to:

Actively engage governments, public and private sectors, academia, civil society, foundations, donors, social action investors and other interested actors to design and scale successful innovations. 

Establish a positive business environment that recognizes the value of innovation to society. 

Prioritize innovations that have the greatest chance of reducing health inequities, and helping to ensure that progress of women’s, children’s and adolescents’ health benefit disadvantaged populations at least as much as wealthier populations. 

Encourage the exchange of skills and experiences.

We have three impact goals for the next year and the five years which are:
1- SURVIVE: End preventable deaths
- Reduce global maternal mortality to less than 70 per 100,000 live births
- Reduce newborn mortality to no more than 12 per 1000 live births in all countries
- Reduce under-5 mortality to no more than 25 per 1000 live births in all countries
- End the epidemics of HIV, tuberculosis, malaria and neglected tropical diseases and other
communicable diseases
- Reduce premature mortality from non-communicable diseases by one-third and promote mental health and well-being
2-GROWTH: Ensure health and well-being
- End all forms of malnutrition, and provide for the nutritional needs of children, adolescents, pregnant and breastfeeding women
- Ensure universal access to sexual and reproductive health care services (including family planning)
and respect for rights
- Ensure access for all girls and boys to quality early childhood development
- Significantly reduce pollution-related deaths and pathologies
- Achieve universal health coverage, including financial risk protection, and access to quality essential services, medicines and vaccines
- Eradicate extreme poverty
- Ensure that all girls and boys complete free, equitable and quality primary and secondary education
- Eliminate all harmful practices and all discrimination and violence against women and girls
- Ensure universal and equitable access to affordable drinking water and adequate sanitation and hygiene conditions
- Develop scientific research, strengthen technological capacities and encourage innovation
- Provide legal identity for all, including birth registration
- Strengthen the global partnership for sustainable development
3-TRANSFORM: Expand enabling environment

• Reduce indoor and ambient air pollution by expanding the use of clean fuels and energy technologies in homes (for cooking, heating and lighting)
• Take action to mitigate and adapt to climate change that affects the health of women, children and adolescents
• Eliminate non-essential uses of lead (in paints, for example) and mercury (in health care and artisanal mining) and ensure the safe recycling of waste containing lead or mercury
• Reduce air pollution and climate-related emissions and improve green spaces using low-polluting technologies and renewable energy

To achieve these objectives we will appeal for funds and we have a total of 9 fundraising strategies: national leadership, financing for health, resilience of health systems, individual potential, community participation, multisectoral action, humanitarian emergencies and situations of fragility, research and innovation, and accountability.

These objectives will be achieved through national and international partnerships.

The first nine indicators:

1) Crude death rates due to:
- diseases of the circulatory system,
- tumors,
- diabetic sugar,
- asthma and other chronic diseases of the lower respiratory tract.
 
2) Maternal mortality rate
 
3) Infant mortality rate
 
4) Number of road accident fatalities
 
5) Quantity of alcohol consumed (in equivalent liters of pure alcohol) per inhabitant aged 15 and over
 
6) Density of doctors and health professionals
 
7) Crude rates of death due to suicide
 
8) Prevalence of regular (or daily) smoking by age group
 
9) Discovery of HIV seropositivity by sex and by year
 
Consumption of psychotropics or anxiolytics (Medicine Agency, CNAMTS)

Project Theory of Change

We believe that access to quality health care at the community level will significantly reduce the number of preventable deaths among children under five from the most common childhood illnesses in settings where health facilities are remote or inaccessible.

 We believe that community health workers, if given the appropriate training and resources, can provide high quality case management for pneumonia, diarrhea, malaria, and malnutrition in children under five. 

We also believe that one of the biggest obstacles to providing high quality community based treatment is the lack of, or ineffectiveness or inefficiency of supply chain systems necessary to ensure availability of essential, life saving medicines at this level.

We believe that an effective and efficient supply chain requires reliable and appropriate transport for the movement of goods, adequate and secure storage to maintain good quality medicines, sufficient quantities of essential medicines available at resupply points and a staff with the knowledge, skills and motivation to accomplish their mission and roles.
 To achieve these necessary prerequisites for system performance, certain elements must be in place. These elements are funding, policies and strategies, tools, processes, communication and information flows, staff with knowledge and skills to achieve the intermediate goal - community health workers have medicines usable and quality when needed for appropriate treatment of common childhood illnesses. We believe that the absence of one or more of these elements will negatively affect the achievement of this objective.

Based on these beliefs, our theory is that if effective and efficient supply chain systems can be created to ensure that community health workers have consistent access to sufficient quantities of high-quality, affordable essential medicines, they will be able to dramatically improve care and treatment for children. This ultimately will contribute, along with other interventions, to our overall goal to reduce childhood mortality for children under five from treatable diseases.

IN CONCLUSION, IT IS POSSIBLE ALL STAKEHOLDERS TAKE PART TO TECHNOLOGICAL CHANGE AND BENEFITS FROM ITS SUCCESS

The approach presented here clearly shows that there is no no miracle recipe, nor simple recipe, for ensure the success of technological change.
It is the quality and richness of the interaction that is established between the different groups of stakeholders and consideration of critical success factors already known that ensure that the change will be more or less easy and, above all, that it will give positive results or not.

The Technology Change Management Guide developed from extensive research on the field and benefiting from the direct input of practitioners
representing each stakeholder group is a tool conducive to arousing and encouraging the collaboration of those who have to live with technological change. He integrates each of the three strategic levers, bringing each participant, according to their group,to reflect first on its logic of action and, then,to take concrete, clearly identified actions based on existing knowledge, to interact effectively with other stakeholders and thus
contribute to the success of technological change besides benefiting from it.

Let us emphasize in conclusion that we are aware that using this guide requires much more time and makes the management of technological change a bit more complex. More energy must be devoted to its preparation and it supposes the acceptance of a questioning more or less large, but real, of the change project. We can therefore say that, for this organizational activity strategic as for many others, "the success has a price”

1- Leveraging social media to improve patient experience: Tapping data from social media and online communities to give health care organisations the ability to track consumer experience and population health trends in real-time

 Awareness campaign to support the zero malaria program through:

  ─ The media, TV channels and broadcasting by Radio

  ─ Billboards, advertising on buses for a period of two months.

  ─ Massive distribution of brochures for the program to the community

  ─ Organize film screenings

  ─ Coordinate work with the health system

    ─ Create a network of people who work for change.

2- Mobile apps for healthcare professionals and patients

In our line of business we use mobile applications to discover new ways to use technology, to monitor work remotely and to communicate (booking medical appointments, etc.).

3- Telemedicine, medical concierge, remote patient monitoring,...

One of the most useful and practical innovations of recent years is remote monitoring technology. The systems can be used by all patients in the comfort of their own homes to reduce the time and financial cost of recurring doctor visits, especially for patients who are located in medical deserts or with reduced mobility.

For example, using a small, network-connected electronic device designed to measure a particular health condition, doctors can remotely analyze a patient's data without the patient having to travel to a hospital, clinic or at his doctor's office. These remote follow-ups often raise ethical questions regarding the security and management of each patient's private data. However, many start-ups are working on continuous improvement to protect data, and innovate by always creating better security barriers.

4- Convenient care: Retail clinics and urgent care centers that provide more convenient and lower-cost care to patients for a number of health issues

5- Telehealth: A more convenient way for consumers to access and increase self-care while potentially reducing office visits and travel time; may also prevent complications and emergency room visits

6- Point-of-care diagnostics: Allow for convenient, timely testing at the point of care (e.g., physician office, ambulance, home, or hospital), resulting in faster, more cohesive patient care

Data is collected by a Routine Health Information System: A system that collects and aggregates health-related information and data at multiple administrative levels within communities and the country.

This module covers the purpose and scope of surveillance, monitoring and evaluation activities, specifically for malaria control programs and the importance of using data to guide decision-making.

Module Objectives
At the end of this module, you will be able to:
• Identify the purpose and scope of surveillance, monitoring and evaluation
• Describe the importance of using data to guide decisions.
• Identify strategies to overcome the barriers and ensuring that health-related data be used to make decisions.
Surveillance:
A systematic and continuous process comprising four main activities:
• Collection of relevant data
• Data aggregation and tabulation
• Analyze and interpret data
• Disseminate and use data and results
Surveillance answers the question: What are we tracking? Some examples are events related to health programs (morbidity, mortality, drug efficacy, insecticide efficacy, etc.)
Followed:
Monitoring aims to establish whether the resources invested (inputs or inputs), the activities undertaken, the quality of these activities (processes), and the number of activities performed (outputs) are proceeding according to plan. Tracking includes regular data collection and analysis to aid in timely decision-making timely, to guide program planning and management, to ensure accountability and finally, to provide a basis for assessment and learning.
Tracking can help answer questions such as:
• Was the program implemented as planned?
• Are the activities of the program implemented in the same way across the
different sites?
• Are program resources used efficiently?
Evaluation :
Evaluation is a process that aims to determine as systematically and objectively as possible: the relevance of the objectives, the efficiency of the resources used, the effectiveness of the design and implementation of the programme, the added value of the programme, the sustainability of the results and/or the impact of a program or intervention. The evaluation aims to provide valuable management data, to judge the value of an intervention and to offer lessons for future programs or policies.
Evaluation can help answer questions such as that :
• Has the implementation of the program led to an improvement in the state of health of the target population ?
• Has the program improved access health services in the population target ?
• Was the program profitable?

Use of Data
Data can be used for many purposes
important. Data should be used primarily to inform decision-making, which takes place at multiple levels from the program level to the policy level.
Here are some examples of how data from a program or intervention can be used:
• Help guide policy development, planning or program decisions.
• Mobilize additional resources for upgrading program level or for future programs.
• Assess whether a policy, plan or program has produced the expected effects.
• Strengthen programs by improving their results, their effectiveness and/or the quality of services provided by programs.
• Identify the factors and/or interventions that influence health status.
• Ensure accountability and help produce activity reports.
• Contribute to learning lessons that can help in the effective implementation of other malaria prevention and control programs.

LIST OF ACRONYMS USED IN THE DOCUMENT:
AHP................................................. .ALLO HYGIENE PLUS
EDI................................Equity, Diversity and Inclusion
PHC.....................................Preliminary Health Care

1. Word from the management

Word of ANANI EFOE ZOGUIDI K
Director of ALLO HYGIENE PLUS (AHP)

Renowned for its tradition of excellence, rigor and innovation, ALLO HYGIENE PLUS is a dynamic place and open, conducive to the achievement of the mostambitious. With this in mind, I am convinced that a equitable, diverse and inclusive community helps to perpetuate and strengthen this tradition.The diversity of ideas, experiences and ways to think and to see the world leads to a proliferation intellectual and creative that allows us to demonstrate forward-thinking and leadership.

Equity, diversity and inclusion are true wealth and together they are the key
an environment conducive to innovation. It's in encouraging the collaboration of people from different backgrounds (culture, age, gender, experience) that
ALLO HYGIENE PLUS will be able to carry out innovative projects
with significant spin-off potential. Why ?
Because the diversity of people and ways thinking leads to better understanding management issues and enables the development of
solutions that have maximum impact for all.

By making equity, diversity and inclusion a theme central to its different spheres of activities, I am firmly convinced that ALLO HYGIENE PLUS will continue to stand out as a major research and transfer institution
in all areas of management.

My commitment to equity, diversity and inclusion is clear: create an environment of research and transfer where everyone feels
respected and valued and ensure that each of the people involved have the opportunity to contribute to this environment in an authentic way.
The next strategic research plan 2022 - 2027 reflects this commitment. Actions aimed at promoting equity, diversity and inclusion in the processes
management of research and transfer are at the heart this plan. In addition, the monitoring of diversity indicators (for example: number of group leaders
research belonging to designated groups, representativeness of teachers receiving awards research of ALLO HYGIENE PLUS) will allow to follow
progress and to act if the results are not up to our ambitions.

ALLO HYGIENE PLUS (AHP) can count on my commitment
to continue to enrich a culture of openness and inclusion. All members of our community must feel that they are welcomed, integrated and
treated fairly. I invite each of them to exploit its full potential and contribute to the success of our establishment.

ANANI EFOE

2. Keys to research excellence

In keeping with a tradition of commitment to excellence and innovation, ALLO HYGIENE PLUS (AHP) anchors the development of this action plan on three key elements:a concrete commitment to equity, diversity and inclusion, a large ecosystem allowing several members of the AHP community to get involved in order to participate in the change of culture, as well as concrete actions that affect all the designated groups. This section aims to describe these three key elements, which represent the foundations of EDI to AHP and whose transversal scope covers all EDI activities for the entire ALLO HYGIENE PLUS community.

2.1 ALLO HYGIENE PLUS (AHP) commitment to equity, diversity and inclusion

ALLO HYGIENE PLUS's commitment to equity, diversity and inclusion was reflected in April 2020.

To coordinate the development and implementation of an EDI policy as well as the implementation actions, a consultant was hired in September 2020. She is entirely dedicated to actions in EDI and reports to the AHP General Secretariat. The scope of his mandate affects the entire AHP community, that is to say its board of directors, the members of its teaching staff, its teachers, its administrative and support staff and its students. She is now supported by an agent and an analyst who help speed up the integration
of EDI in all practices and processes in place at AHP.

The process of drafting the policy took place over a period of several weeks and several members of the AHP community provided input. Indeed, as of December 2020, a vast consultation with management, students, faculty and staff a allowed us to develop a common vision and ensure that the policy meets the needs of all members of the community.

2.2 Equity, Diversity and Inclusion (EDI) ecosystem at ALLO HYGIENE PLUS

To promote the commitment of all actors to EDI, a governance structure is put in place. It aims to guide the members of management as well as the members of the various units who contribute to the application of the EDI Policy and the implementation of the action plan.

Several internal and external contributors play a key role in the development of a culture of fairness, diversity and inclusion at AHP

The main internal actors of the ecosystem of EDI at ALLO HYGIENE PLUS are:

The Research and Transfer Department (RTD), whose collaboration is essential within the framework the development and implementation of this action plan, Equity, Diversity and Inclusion:
keys to research excellence. The RTD integrates EDI into its practices and support activities for faculty members.

The Department of Faculty Affairs (DFA), whose members work closely with the EDI team in the deployment of the various initiatives with all faculty members

The Department of Studies, which plays an important role in integrating EDI into the various programs studies at AHP. The Registrar’s team, which is part of the Department of Studies, must also ensure that its processes and practices evolve to meet the needs of students from minority groups.

The Human Resources Department (HRD), which is an ally in the implementation of EDI actions with staff members. EDI team collaborates on a regular basis with several HRD members.

Finally, the student table on EDI and well-being was created in August 2020 in order to ensure the coordination and advancement of student projects and initiatives in terms of EDI in Allo Hygiene Plus . The table also aims to facilitate exchanges between key players in change within the student community and to promote the commitment of their peers. For the general secretariat and the other school units working in EDI, the table allows them to remain informed of student projects and initiatives, to ensure support and make them last. This table is made up of 10 students which represent the student associations and various committees, including the AHP diversity committee, as well as 3 staff members (EDI counselor, health and well-being advisor, coordinator with student life).

To these internal contributors is added the entire community of Allo Hygiene Plus, which is regularly Consulted as part of equity, diversity and inclusion projects: students, staff members, faculty members.

2.3 A visible commitment for all designated groups

To concretely illustrate the efforts made at ALLO HYGIENE PLUS (AHP) to pursue the establishment of an EDI culture within its entire community, this section presents various initiatives. They are concrete examples of AHP's commitment to strive for an ideal of equity and social justice. The path remains long to go before reaching this ideal.

INTRODUCTION

Health financing system achieves: a technical explanation 

Health financing is more than just raising money for health. It's also about who gets the bill, when it's paid, and how the money raised is spent.

The three fundamental areas of health financing are:

1. Collect enough money for health;

 2. Remove financial barriers to access and reduce financial risks associated with illness; 

3. Make better use of available resources;

Health care is expensive. One way or another, doctors and nurses, drugs and hospitals have to be paid for.

Direct payments :Direct payments have serious health implications. Charging people at the service level discourages them from using services (especially for health promotion and prevention) and encourages them to postpone medical examinations. This means that they do not receive early treatment despite a much higher potential for recovery.

Direct payments also undermine household finances. A lot of people have to pay it at the benefit level to get treatment and they end up by encountering serious financial difficulties. Estimates of the number of victims financial disaster (defined as having to pay more than 40% of household income directly for medical care.

Catastrophic healthcare expenses are not necessarily caused by expensive medical procedures or a single expensive event.
For many households, relatively low payments can also lead to financial disaster. A regular occurrence of medical bills can lead sufferers to poverty,
for example, chronic illness or disability .
Not only do out-of-pocket expenditures deter people from using health services and cause financial stress, but they also lead to inefficiency and inequity in the way resources are used. They encourage overuse by those who can afford it and underuse by those who cannot afford it.

THE ACTION OF THE ORGANIZATION (AHP) TOWARDS THE POPULATION

For this, the AHP organization has set up a system of adaptation Fund pooled:
What is this system?
Pooled funds
Progress towards universal coverage depends on securing adequate funds from a sufficiently large constituency of individuals, supplemented where necessary with support from donors and government revenue
and then spend those funds on the services people need. The more people who share the financial risk in this way, the lower the financial risk any individual is exposed to. In general, the larger the group greater, the more it is able to bear the financial risks. By this same reasoning, groups of a few participants only experience what actuaries call “extreme fluctuations in usage and claims.” For a credit union to exist, the money must be invested in it and therefore a prepayment system is necessary. Prepaying simply means that people pay when they are healthy and then draw on pooled funds when they get sick.

IMPROVE HEALTH

Increased use of relatively inexpensive services that help prevent disease can reduce the need for expensive treatments later. For example, screening, diagnosis and treatment of high blood pressure and high cholesterol can help prevent a heart attack or stroke and therefore the need for treatments such as angioplasty for revascularization arteries. Screening for breast cancer and colon cancer can find cancer early and prevent the need for expensive treatments for late-stage cancer (as well as increase the chance of survival).

REDUCE REIMBURSEMENT FOR CARE PROVIDED

*Lower fees

Insurance companies and the organization (AHP) negotiate lower fees with hospitals and other institutions and with health care providers, or they may simply impose these fees.

*Prospective payment systems
In these systems, health care providers are paid a fixed amount regardless of the extent of the care services provided. How this amount is determined varies. Sometimes providers are paid based on the person's diagnosis. In some systems, providers are paid a fixed annual amount to provide health care to a person, regardless of the services that person uses (capitation systems).

*Reduced drug costs

The use of generic drugs or, where appropriate, branded drugs with a better cost-effectiveness ratio can help reduce the cost of drugs. Ways to reduce drug costs include:

- Train health care providers on cost-effective use of medicines
- Limit the quantity of drugs advertised and marketed to individuals and suppliers
- Establish rules on how hospitals and other institutions should use drugs (thereby limiting unnecessary use of expensive drugs)
- Authorize the government to negotiate lower drug prices for people covered by government insurance
- Authorize the importation of drugs for sale in the country

NB: we held on to the subsidization of the pharmacy and the treatment of certain diseases such as malaria.
Pharmacies located in the heart of hospitals are subsidized by a reduction in drug prices, yes a reduction within everyone's reach compared to ordinary pharmacies.

*Reduce overhead
These overheads include administrative costs, professional liability insurance, and profit from for-profit hospitals and insurance companies.

Decrease overhead costs for healthcare providers
Thus, the following measures can help reduce provider overhead:
- Ensure that payment amounts and rules are the same for all insurance companies
- Require insurance companies to pay all bills submitted by healthcare providers
- Standardize the cost of the same service throughout the country

*Competition
We have competition as follows:
Competition between health care providers for patients and between insurance companies for customers should encourage cost reduction. For example, to attract patients, providers may charge less than their competitors for a similar service. However, people usually do not know in advance what the provider will charge, and if they do know they often cannot use this knowledge, in part because their insurance plans often require them to consult defined providers and because they are limited in their ability to judge the quality of care. Also, because the cost of medical care is subsidized for most people (for example, through employer-paid health insurance and tax deductions), people are less motivated to shop around than they might be. are mostly other purchases. Thus, competition is most effective in reducing costs and maintaining quality when it exists between large organizations such as insurance companies, which compete for contracts with corporations or government, or between hospitals , who compete for contracts with insurance companies.

Competition also contributes to health care costs (mainly administrative). Dealing with the numerous rules for submission of claims, assessment and many other services (such as referrals to healthcare professionals and coding) imposed by different insurance companies, takes up more time for healthcare providers , their secretariat, or both.

*Other solution supported by AHP organization:

- Distribution to the most disadvantaged of free health cards financed by AHP, which would guarantee their holders the same benefits as those of compulsory public health insurance.
- Encouragement for the rational use of medicines consisting of including at least certain essential medicines in public pre-financing programmes.
- Reduction of out-of-pocket payments to the patient as pre-financing systems are put in place.
Improving the terms of exemption from direct payment of services by patients from disadvantaged categories by covering at least the loss of earnings using public funds.
- Reducing the indirect expenses of indigents in need of skilled care by setting up community funds to cover, for example, transport costs and the provision of premises in public hospitals in which caring relatives patients can cook and sleep.
- Acceptance of commercially oriented private health services as a complement and not a substitute for public health services and authorization of their extension only insofar as they do not hinder the development of a comprehensive, efficient and equitable health system, in which the rich subsidize the care of the poor.

The fight against malaria cannot be won without the active participation of communities in affected countries. Multisectoral and Interpays partnerships will be necessary for the achievement of targets by 2030.
Main objective of the Plus hygiene organization is to ensure that sufficient resources are available to eliminate malaria, including:
- ensure that the elimination of malaria continues to
appear among political and development priorities
- Continue social mobilization, including a popular movement to end malaria
- continue and increase funding for the fight against
malaria, including national financing and the use of innovative funding
- Mobilize the private sector to play an important role in eliminating malaria.
We organize marches, demonstrations and celebrations to support efforts to combat malaria in order to be able to pay particular attention to the level of private companies, government and the population in order to be able to help us financially by donations to support our programs.
The organization continues its funding by subsidies and the collection at the level of communities (farmers ...).

In history, my launch in entrepreneurship to meet this challenge started with a fundraising on social networks such as Facebook and how it works:
The organization is both for profit on the one hand and non -profit on the other in the context of helping vulnerable. We proceed by the publication of our productions or services from my field of activity such as disinfection of public places, health centers, premises. etc ... and disinsection. On social networks to win contracts and donations.
It is with this in mind that we ask foundations to support our programs through subsidy as an example Bill and Melinda Gates.
It was not easy, but I kept the courage to help my community to this day. I like my community.

https://www.linkedin.com/in/ef...